
<table>
    <tr>
        <td>Name:</td>
        <td><?=form_input('name')?></td>
    </tr>
    </tr>
        <td>Department:</td>
        <td>
            <select name="dtype">
                <option value="0">Computer Science</option>
                <option value="1">Information System</option>
                <option value="2">Information Technology</option>
            </select>
        </td>
    </tr>
    <tr>
        <td>Email Address:</td>
        <td><?=form_input('eadd')?></td>
    </tr>
    <tr>
        <td>Password:</td>
        <td><?=form_input('pass')?></td>
    </tr>
    <tr>
    	<td><input type="checkbox" name"confirm"></td>
    	<td>Confirm Request Account</td>    		
    </tr>
</table>
<input type="submit" value="Request" name="request">
<?php form_close()?>
